• Home
• Contact
• About
• Calendar
• Press
• Employment

Consumer Complaint Form

SECTION A
Notice: Under the Public Information Act, this complaint and
the complainant's identity are subject to disclosure.

You, as the complaining party
I represent:	Myself A Company
First Name:
Last Name:
Company Name:
Mailing Address:	Mailing Address line 2
City:		State:	AK AL AR AS AZ CA CO CT DC DE FL FM GA GU HI IA ID IL IN KS KY LA MA MD ME MH MI MN MO MP MS MT NC ND NE NH NJ NM NV NY OH OK OR PA PR PW RI SC SD TN TX UT VA VI VT WA WI WV WY AP AE	Zip:
Telephone  Numbers: ###-###-####	Work: Home: Cell:   Fax:
Email Address:

SECTION B

Manufacturer
Name:
Address:	Manufacturer Address line 2
City:		State:	AK AL AR AS AZ CA CO CT DC DE FL FM GA GU HI IA ID IL IN KS KY LA MA MD ME MH MI MN MO MP MS MT NC ND NE NH NJ NM NV NY OH OK OR PA PR PW RI SC SD TN TX UT VA VI VT WA WI WV WY AP AE	Zip:
Telephone  Numbers: ###-###-####	Work:   Fax:
Retailer
Name:
Address:	retailer address line 2/label>
City:		State:	AK AL AR AS AZ CA CO CT DC DE FL FM GA GU HI IA ID IL IN KS KY LA MA MD ME MH MI MN MO MP MS MT NC ND NE NH NJ NM NV NY OH OK OR PA PR PW RI SC SD TN TX UT VA VI VT WA WI WV WY AP AE	Zip:
Telephone  Numbers: ###-###-####	Work:   Fax:
Installer
Name:
Address:	installer address line 2
City:		State:	AK AL AR AS AZ CA CO CT DC DE FL FM GA GU HI IA ID IL IN KS KY LA MA MD ME MH MI MN MO MP MS MT NC ND NE NH NJ NM NV NY OH OK OR PA PR PW RI SC SD TN TX UT VA VI VT WA WI WV WY AP AE	Zip:
Telephone  Numbers: ###-###-####	Work:   Fax:
Other
Company Name:
First Name:
Last Name:
Address:	other address line 2
City:		State:	AK AL AR AS AZ CA CO CT DC DE FL FM GA GU HI IA ID IL IN KS KY LA MA MD ME MH MI MN MO MP MS MT NC ND NE NH NJ NM NV NY OH OK OR PA PR PW RI SC SD TN TX UT VA VI VT WA WI WV WY AP AE	Zip:
Telephone  Numbers: ###-###-####	Work:   Fax:

SECTION C

Please state the nature of the complaint

Character Limit: 4000   Characters Remaining: 4000

SECTION D
Home Information, if applicable

Home Sections:	empty table header HUD Label or Texas Seal* Serial Number Width Length 1 label number section 1 serial number section 1 width number section 1 length number section 1 2 label number section 2 serial number section 2 width number section 2 length number section 2 3 label number section 3 serial number section 3 width number section 3 length number section 3 4 label number section 4 serial number section 4 width number section 4 length number section 4 * HUD Labels and Texas seals can be found on a data plate attached to the back end of the   home, opposite the tow bar end. Labels and seals are 10 characters long with a three   letter prefix followed by 7 digits, such as TEX0000000. Do not include any dashes in the   number. Each section of the home will have a different number.
Manufacturer Name:
Model Year:		Model Name:
Physical Address  of Home:	Physical Address of home line 2
City:		State:	AK AL AR AS AZ CA CO CT DC DE FL FM GA GU HI IA ID IL IN KS KY LA MA MD ME MH MI MN MO MP MS MT NC ND NE NH NJ NM NV NY OH OK OR PA PR PW RI SC SD TN TX UT VA VI VT WA WI WV WY AP AE	Zip:
County where  home is located:	ANDERSON ANDREWS ANGELINA ARANSAS ARCHER ARMSTRONG ATASCOSA AUSTIN BAILEY BANDERA BASTROP BAYLOR BEE BELL BEXAR BLANCO BORDEN BOSQUE BOWIE BRAZORIA BRAZOS BREWSTER BRISCOE BROOKS BROWN BURLESON BURNET CALDWELL CALHOUN CALLAHAN CAMERON CAMP CARSON CASS CASTRO CHAMBERS CHEROKEE CHILDRESS CLAY COCHRAN COKE COLEMAN COLLIN COLLINGSWORTH COLORADO COMAL COMANCHE CONCHO COOKE CORYELL COTTLE CRANE CROCKETT CROSBY CULBERSON DALLAM DALLAS DAWSON DEAF SMITH DELTA DENTON DEWITT DICKENS DIMMIT DONLEY DUVAL EASTLAND ECTOR EDWARDS EL PASO ELLIS ERATH FALLS FANNIN FAYETTE FISHER FLOYD FOARD FORT BEND FRANKLIN FREESTONE FRIO GAINES GALVESTON GARZA GILLESPIE GLASSCOCK GOLIAD GONZALES GRAY GRAYSON GREGG GRIMES GUADALUPE HALE HALL HAMILTON HANSFORD HARDEMAN HARDIN HARRIS HARRISON HARTLEY HASKELL HAYS HEMPHILL HENDERSON HIDALGO HILL HOCKLEY HOOD HOPKINS HOUSTON HOWARD HUDSPETH HUNT HUTCHINSON IRION JACK JACKSON JASPER JEFF DAVIS JEFFERSON JIM HOGG JIM WELLS JOHNSON JONES KARNES KAUFMAN KENDALL KENEDY KENT KERR KIMBLE KING KINNEY KLEBERG KNOX LA SALLE LAMAR LAMB LAMPASAS LAVACA LEE LEON LIBERTY LIMESTONE LIPSCOMB LIVE OAK LLANO LOVING LUBBOCK LYNN MADISON MARION MARTIN MASON MATAGORDA MAVERICK MCCULLOCH MCLENNAN MCMULLEN MEDINA MENARD MIDLAND MILAM MILLS MITCHELL MONTAGUE MONTGOMERY MOORE MORRIS MOTLEY NACOGDOCHES NAVARRO NEWTON NOLAN NUECES OCHILTREE OLDHAM ORANGE OUT OF STATE PALO PINTO PANOLA PARKER PARMER PECOS POLK POTTER PRESIDIO RAINS RANDALL REAGAN REAL RED RIVER REEVES REFUGIO RETAILER LOT ROBERTS ROBERTSON ROCKWALL RUNNELS RUSK SABINE SAN AUGUSTINE SAN JACINTO SAN PATRICIO SAN SABA SCHLEICHER SCURRY SHACKELFORD SHELBY SHERMAN SMITH SOMERVELL STARR STEPHENS STERLING STONEWALL SUTTON SWISHER TARRANT TAYLOR TERRELL TERRY THROCKMORTON TITUS TOM GREEN TRAVIS TRINITY TYLER UNKNOWN UPSHUR UPTON UVALDE VAL VERDE VAN ZANDT VICTORIA WALKER WALLER WARD WASHINGTON WEBB WHARTON WHEELER WICHITA WILBARGER WILLACY WILLIAMSON WILSON WINKLER WISE WOOD YOAKUM YOUNG ZAPATA ZAVALA	Date Installed:	mm/dd/yyyy
Purchase Date:	mm/dd/yyyy	Purchased new or used Purchased New      Purchased Used
Was home purchased by itself (as personal property) or with land (as real property)?				Election type personal or real Personal      Real
Do you have a title or a Statement of Ownership and Location in your name?				have statemet of ownership in your name answers yes or no Yes      No
Specific instructions or directions to location of home	Character Limit: 4000   Characters Remaining: 4000

By submitting this complaint you swear, under penalty of perjury, that the matters set forth in this complaint are, to the best of your knowledge, true and correct.

---

Copyright © 2016 Texas Department of Housing and Community Affairs
For assistance with this system, please contact Manufactured Housing Customer Service at 1-800-500-7074
or email complaints@tdhca.state.tx.us.